Healthcare Provider Details

I. General information

NPI: 1306738422
Provider Name (Legal Business Name): SHAMEEKA LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2861 WOMBLE RD
SAN DIEGO CA
92106-6025
US

IV. Provider business mailing address

3802 ROSECRANS ST # 621
SAN DIEGO CA
92110-3114
US

V. Phone/Fax

Practice location:
  • Phone: 858-522-0695
  • Fax:
Mailing address:
  • Phone: 858-522-0695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLEP4620
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: